Synopsis
Refer appropriate liver disease early, understand UK selection and graft complications, and protect recipients through precise immunosuppression, infection and long-term risk management.
- Early transplant referral creates time to assess reversibility, frailty, infection, cancer, cardiopulmonary risk, adherence and the patient's goals before crisis occurs.
- UK listing and allocation follow current NHSBT policies; UKELD, super-urgent status and disease-specific criteria support but do not replace transplant-centre judgement.
- Indications include decompensated chronic liver disease, acute liver failure, selected HCC and certain metabolic, cholestatic or symptom-dominant disorders.
Key red flags
Coagulopathy with encephalopathy in a patient without known cirrhosis can deteriorate within hours. Contact a transplant centre early while pursuing cause-specific emergency management.
Investigation priorities
Define liver prognosis, comorbidity, technical feasibility and expected net transplant benefit.
Management branches
Liver disease has decompensated, progressed despite treatment, produced qualifying HCC or caused acute liver failure.
- Contact regional hepatology or the transplant centre early, supplying diagnosis, decompensation episodes, current physiology, infection status, renal trajectory, imaging and relevant alcohol or substance history.
- Optimise nutrition, frailty, ascites, encephalopathy, infection control and disease-specific treatment while assessment proceeds, avoiding a passive wait for a score to cross a threshold.
The recipient is clinically stable after the early transplant period and routine care is shared locally.
Key medicines
TacrolimusUse the exact immediate- or prolonged-release product and individual dose prescribed by the transplant team; adjust only against valid trough concentrations, graft status, adverse effects and interactions.